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Enhancing Nonmass Lesions in the Breast: Evaluation with Proton (¹H) MR Spectroscopy¹

¹ From the Department of Radiology, Breast Imaging Section H-118, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021. From the 2006 RSNA Annual Meeting. Received September 21, 2006; revision requested November 14; revision received January 17, 2007; accepted February 1; final version accepted March 16. Address correspondence to L.B. (e-mail: liabartella{at}hotmail.com).

Purpose: To prospectively evaluate the sensitivity and specificity of proton (hydrogen 1 [¹H]) magnetic resonance (MR) spectroscopy for diagnosing malignant enhancing nonmass lesions identified at breast MR imaging, with histologic examination as the reference standard.

Materials and Methods: In this HIPAA-compliant, institutional review board–approved study, in which all participants gave written informed consent, proton (¹H) MR spectroscopy of the breast was performed in suspicious or biopsy-proved malignant lesions that were 1 cm or larger at MR imaging. Single-voxel proton (¹H) MR spectroscopic data were collected. MR spectroscopic findings were defined as positive if the signal-to-noise ratio of the choline resonance peak was 2 or greater and as negative in all other cases. MR spectroscopic results were then compared with histologic findings, and statistical analysis was performed.

Results: In 32 women (median age, 48.5 years [range, 20–63 years]) with enhancing nonmass lesions, the median lesion size at MR imaging was 2.8 cm (range, 1.2–9.0 cm). At histologic analysis, 12 (37%) of 32 lesions were malignant and 20 (63%) were benign. Positive choline findings were present in 15 of 32 lesions, including all 12 (100%) cancers and three (15%) of 20 benign lesions, giving proton (¹H) MR spectroscopy a sensitivity of 100% (95% confidence interval [CI]: 74%, 100%) and a specificity of 85% (95% CI: 62%, 97%) for detection of enhancing nonmass lesions. For 25 lesions with unknown histologic features, proton (¹H) MR spectroscopy would have significantly (P < .01) increased the positive predictive value of biopsy from 20% to 63%. If biopsy had been performed for only those lesions with positive choline findings at proton (¹H) MR spectroscopy, biopsy might have been avoided for 17 (68%) of 25 lesions, and no cancers would have been missed.

Conclusion: Proton (¹H) MR spectroscopy had 100% sensitivity and 85% specificity for the detection of malignancy in enhancing nonmass lesions.

© RSNA, 2007

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